Advocacy Update Oct. 14, 2025
IN THIS ISSUE / Oct. 14, 2025
Ongoing government shutdown may delay Medicare reimbursement
Cigna delays implementation of controversial downcoding policy in California
Federal News
Ongoing government shutdown may delay Medicare reimbursement
The Academy continues to monitor the current government shutdown and its impact on dermatologists. The Medicare program is covering and paying for physician services backed by advance appropriations, but it will not cover Medicare telehealth visits.
Medicare Administrative Contractors (MACs) have been instructed to temporarily hold claims for 10 business days, though this should have minimal effect on physicians due to the 14-day payment floor. Physicians may continue to submit claims during this period, but payment will not be released until the hold is lifted.
For the latest information, physicians should monitor their MAC’s website and this CMS web page.
AADA News
2026 Advocate of the Year nominations open
Each year, the AADA recognizes outstanding grassroots advocacy efforts through the Advocate of the Year Award. The goal of the award is to promote year-round advocacy and acknowledge the positive effects of a single advocate. Nominations are due by Oct. 31, 2025. Contact grassroots@aad.org with any questions.
Payer Advocacy
Cigna delays implementation of controversial downcoding policy in California
Cigna will pause implementation of its new “Evaluation and Management Coding Accuracy” reimbursement policy pending review by the California Department of Managed Health Care (DMHC). The pause follows the California Medical Association’s (CMA) inquiry to state regulators about the policy’s legality, which prompted DMHC to engage with Cigna. The AADA is involved in ongoing discussions with the carrier on its program to mitigate the impact on dermatologists in California.
The policy, originally scheduled to take effect Oct. 1, 2025, would allow Cigna to automatically downcode higher-level evaluation and management (E/M) services whenever the plan determines that documentation does not support the billed level. Physicians disputing these decisions would be required to file an appeal and submit medical records by fax — a process CMA has warned creates unnecessary administrative burdens and costs.
The CMA has cautioned that the policy appears to violate state law, is inconsistent with nationally recognized coding standards, and functions as a barrier to appropriate reimbursement and patient care.
Effective Oct. 1, Cigna initiated a pre-payment review of level 4 and 5 E/M CPT codes for those physicians identified as outliers frequently reporting the higher-level codes. The program will continue in all other states served by the carrier.
AADA News
Learn to advocate for Medicare physician payment reform
Did you miss the 2025 Legislative Conference? Recorded sessions are now available on the AAD’s Learning Center.
Learn about Medicare physician payment policy, how the AADA is advocating for reform, and how you can get involved in advocacy.
AADA News
Support dermatology champions through SkinPAC
As of Oct. 9, SkinPAC has raised $914,045 from 812 individuals. Contribute online at www.skinpac.org or by texting SkinPAC to 71777.
Help us keep up the momentum as we advocate for Medicare physician payment reform! SkinPAC helps strengthen our relationships on Capitol Hill and reinforces our grassroots and lobbying efforts.
Email skinpac@aad.org with any questions.
The political purpose of the American Academy of Dermatology Association Political Action Committee ("SkinPAC") is to solicit and receive contributions to be used to make political campaign expenditures to those candidates for elective office, and other federal political committees, who demonstrate understanding and interest in the view and goals of the American Academy of Dermatology Association.
Contributions to SkinPAC are not deductible for federal income tax purposes. Contributions to SkinPAC must be made from your funds and may not be reimbursed. SkinPAC cannot accept contributions from corporate accounts. Any recommended contribution amount is merely a suggestion. All AADA members have the right to contribute more or less or refuse to contribute without reprisal. Federal law prohibits us from accepting contributions from foreign nationals. Federal law requires us to use our best efforts to collect and report the name, physical address, occupation, and name of the employer whose contributions exceed $200 in a calendar year.
